Neurotrophic Keratitis

When we think of eye health, common conditions like dry eyes, cataracts, or glaucoma might
come to mind. But there’s a lesser-known condition that can have serious implications if left
untreated: Neurotrophic keratitis. Understanding this condition is important especially for those
with certain risk factors.

What Is Neurotrophic Keratitis?

Neurotrophic keratitis is a degenerative disease of the cornea, the clear, dome-shaped surface
that covers the front of the eye. The damage is within the trigeminal nerve (cranial nerve V)
which can lead to a loss of sensation. This damage prevents the eye from sensing irritation or
injury, which disrupts the natural healing process and leaves the cornea vulnerable to further
damage and complications.

Why Is Corneal Sensation Important?

The corneal nerves trigger protective reflexes, like blinking and tearing. They play a vital role in
maintaining the health and integrity of the eye’s surface. When these nerves are impaired, even
a minor injury or infection can go unnoticed and worsen without the body’s normal healing
responses.

What Causes Neurotrophic Keratitis?

The underlying cause of NK is always related to damaged trigeminal nerve, some etiologies of
NK include the following but not limited to:

• Herpes simplex or herpes zoster (shingles) infections
• Eye surgeries, especially those involving the cornea or retina such as cataract surgery or LASIK
• Diabetes, which can lead to nerve dysfunction
• Chronic dry eye disease
• Chemical burns or trauma
• Neurological conditions like multiple sclerosis or brain tumors

Symptoms

A sign of NK is a lack of symptoms. Because the cornea loses sensitivity, patients often don’t
feel pain or discomfort even when damage is occurring. However, some signs that may arise
include:

• Redness
• Blurry vision
• Dryness
• Light sensitivity
• A persistent feeling of something in the eye
• In advanced cases: corneal ulcers, scarring, or even vision loss

How Is It Diagnosed?

An eye care professional will typically diagnose NK through:

• A detailed medical and eye history
• Measuring corneal sensitivity with Cochet-Bonnet Esthesiometer
• Using special dyes to check for damage on the cornea
• Imaging techniques to assess the health of corneal nerves

Early diagnosis is key to preventing serious complications. So make sure to get an annual eye
check!

Treatment Options

Treating neurotrophic keratitis focuses on protecting the eye and promoting healing, since the
natural repair mechanisms are impaired. Depending on the severity, treatments may include:

• Lubricating eye drops or gels to prevent dryness
• Therapeutic contact lenses to protect the cornea
• Autologous serum eye drops (contains growth factors to heal the eyes)
• Platelet rich plasma eye drops (similar to serum drops with higher concentration of growth factors)
• Amniotic membrane (tissue derived from the amniotic sac)
• New therapies, such as Cenegermin (a recombinant nerve growth factor approved to treat NK)
• Surgical Intervention

If you’re noticing symptoms of dry eyes, it could potentially manifest as Neurotrophic Keratitis.
Please contact us to schedule a comprehensive dry eye evaluation.

– Lucy Ton, OD